| NPI | 1710373196 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2016-0084) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 13066) |
| 363A00000X Physician Assistant (Licence: WI 4784) | |
| Enumeration Date | 2015-04-12 |
| Last Update Date | 2024-01-17 |